闭合性肾损伤的诊断与治疗(附108例报告)

Diagnosis and treatment of close renal injury (Report of 108 cases)

目的 探讨肾脏损伤的诊断与治疗 ,最大限度地保留有功能的肾组织。方法 回顾分析10 8例闭合性肾损伤的诊断和处理。结果 B超检出阳性率为 74.19% ,CT检出阳性率为 10 0 %。对 84例Ⅰ类、Ⅱ类肾损伤及 3例Ⅲ类肾损伤行保守治疗 ,Ⅲ类肾损伤行选择性肾动脉栓塞治疗 4例 ,Ⅲ类肾损伤行肾修补术 3例 ,Ⅲ类肾损伤行肾部分切除术 7例 ,Ⅲ类肾损伤 6例及Ⅳ类肾损伤 1例行肾切除术。手术治疗 17例 ,死亡 1例。结论 B超可初步判断肾脏损伤情况 ,CT可准确判断肾脏损伤程度。对Ⅰ类、Ⅱ类及Ⅲ类肾损伤应尽量行非手术治疗 ,对Ⅳ类肾损伤应尽早行手术治疗。

Objective To evaluate the diagnosis and therapy methods of renal injury so as to increase the opportunities for retaining kidney tissues as much as possible.Methods The diagnosis and treatment for 108 cases of renal injury were closely studied.Results 74.19% of the patients could be found by B ultrasonography and 100% by CT.84 patients with type Ⅰ or type Ⅱ and 3 patients with type Ⅲ were successfully treated with conservative method.4 patients with type Ⅲ were successfully treated with selective embolization of renal artery,3 patient repaired,7 patients with partial nephrectomy.Nephrectomy was carried out in 6 patients with type Ⅲ and 1 patient with type Ⅳ.17 cases by operation,and one of which died.Conclusion B Ultrasonography is a initial method for the primary evaluation of renal injury.However,CT is more rapid and accurate.Renal injury in type Ⅰ～Ⅲ should be treated with nonsurgical methods as much as possible,but type Ⅳ should be treated with surgical methods as early as possible.